Rinsho Ketsueki
Online ISSN : 1882-0824
Print ISSN : 0485-1439
ISSN-L : 0485-1439
Volume 45, Issue 9
Displaying 1-13 of 13 articles from this issue
  • Noriko DOKI, Yasuyuki SAITO, Nahoko HATSUMI, Hiroyuki IRISAWA, Tohru S ...
    2004 Volume 45 Issue 9 Pages 1017-1022
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 51-year-old female with acute myeloid leukemia was admitted to our hospital in December 2001. Though she had undergone two courses of induction chemotherapy (idarubicin hydrochloride+cytarabine), she failed to achieve a complete remission. In April 2002, while in non-complete remission, she subsequently underwent total body irradiation (TBI) and treatment with cyclophosphamide (CY) and etoposide (VP-16) before receiving an allogeneic peripheral blood stem cell transplant from her HLA-identical brother. For graft-versus-host disease (GVHD) prophylaxis, she was given tacrolimus and methotrexate. The infused CD34 positive cells provided 8.1×106 cells per kg. Engraftment was obtained on post-transplant day 14, and there was no evidence of clinical acute GVHD. The use of tacrolimus was discontinued on post-transplant day 60. As there was no occurrence of clinical acute GVHD, the patient received a donor lymphocyte infusion (CD3 cells 0.57×107 cells per kg) on post-transplant day 105. On day 132, however, she complained of coughing and fever, and on day 135, she was admitted to our hospital again for dyspnea. A CT scan demonstrated ground-glass opacity in the right pulmonary lobe. After considering her clinical course, symptoms, blood gas, CT scans, etc., we suspected interstitial pneumonia. The dyspnea progressively worsened, however, and despite the use of mechanical ventilation from day 143, the patient died on day 149. From the day she was admitted till the day she was intubated, she was unable to produce sputum.
    Autopsy findings revealed yellow-white tracheal pseudomembranes, as well as Aspergillus hyphae in the trachea, bronchus, and bilateral lungs. These findings are characteristic of Aspergillus tracheobronchitis. The clinical course of Aspergillus tracheobronchitis in allogeneic stem cell transplant recipients is, however, different from that of the usual invasive Aspergillus infection, and although Aspergillus tracheobronchitis is a very rare disease, attention should be paid to the possibility of its occurrence.
    Download PDF (531K)
  • Yasushi KUBOTA, Masayuki SANO, Sachie NAKAZATO, Naoko TSUNEYOSHI, Rika ...
    2004 Volume 45 Issue 9 Pages 1023-1027
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    An 83-year-old man without history of the hemorrhagic diathesis was admitted to our hospital with a 4-months history of purpura and subcutaneous hematoma. He had an extraordinarily prolonged activated partial thromboplastin time, and his factor VIII (F VIII) activity level was 0.2%. A study revealed the existence of an IgG type anti-F VIII inhibitor at a titer of 1004 Bethesda units/ml. He received recombinant factor VIIa and immunosuppressive therapy with cyclophosphamide, prednisolone and cyclosporin, but despite this the titer of F VIII inhibitor remained high. Although the inhibitor disappeared after methylprednisolone mini-pulse therapy, the patient died of opportunistic infections with cytomegalovirus and pneumocystis carinii. The majority of patients with acquired F VIII inhibitor belong to the elderly population, and the standard therapeutic strategy to eliminate the acquired F VIII inhibitor has not been established. Those patients with high titers of F VIII inhibitor require particularly long term immunosuppressive therapy. Therefore, it is important to bear in mind treatment-related opportunistic infections in a case with a high titer of acquired F VIII inhibitor.
    Download PDF (470K)
  • Kazuyuki MURASE, Takuya MATSUNAGA, Naoko TAKEUCHI, Akihito FUJIMI, Ris ...
    2004 Volume 45 Issue 9 Pages 1028-1032
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A seventy-six year old female patient with chronic myelogenous leukemia (CML), (chronic phase), was treated with imatinib and obtained a major cytogenetic response after 6 months of treatment. However, resistance to imatinib appeared 9 months later due to an ABL gene point mutation, and the patient's platelet count and BCR/ABL positive rate had remarkably increased. We discontinued imatinib and used IFNα or hydroxyurea, resulting in the disappearance of the ABL gene mutation clone. After that, we obtained a secondary hematologic response with the administration of imatinib.
    Download PDF (472K)
  • Koh YAMAMOTO, Minako YOSHIDA, Masahide YAMAMOTO, Manabu OHKI, Tohru MI ...
    2004 Volume 45 Issue 9 Pages 1033-1038
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 57-year-old man was referred to our hospital because of elevated ALP. CT and MRI scans together with abdominal angiography showed multiple masses in his abdomen and portal vein obstruction. A diagnostic laparoscopic examination revealed a tumor of 3 cm × 3 cm near the portal vein and para-aortic lymphadenopathy. Histopathological examination of the tumor showed abnormal follicles with poorly formed germinal centers, scattered large spindle cells with proliferation of small lymphocytes, and hypervascular interfollicular tissue. The spindle cells were positive for follicular dendritic cell markers CD21, CD35, and epithelial membrane antigen. The diagnosis was made of a follicular dendritic cell (FDC) tumor in Castleman's disease (CD) of the hyaline-vascular type. Although the portal vein was obstructed by the FDC tumor, blood flow to the liver was retained by collateral vein. The patient did not show any response to four courses of CHOP therapy and died of obstructive jaundice, biliary tract infection and sepsis. So far, 17 cases of FDC tumor complicating CD have been reported, with a poor prognosis in all cases.
    Download PDF (546K)
  • Yoshinori MANO, Kenji YOKOYAMA, Chien-kang CHEN, Yuiko TSUKADA, Yasuo ...
    2004 Volume 45 Issue 9 Pages 1039-1043
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 55-year-old man presented with jaundice and edema of the right leg. Tests of the peripheral blood and bone marrow showed leukocytopenia with 6% blasts and 38.3% of myeloperoxidase-positive blasts, respectively. Computed tomography (CT) scanning disclosed thickening of the common bile duct wall. Granulocytic sarcomas were also found at the left chest wall and the pelvic floor. Endoscopic retrograde cholangiopancreatography confirmed the narrowing of the common bile duct. Biopsy specimens of the common bile duct and pelvic masses revealed myeloblastic infiltration. After placement of a naso-biliary drainage tube, chemotherapy consisting of cytarabine (100 mg/m2/day for 7 days) and idarubicin (12 mg/m2/day for 3 days) was commenced. The dose of idarubicin was not modified. No serious complications, including delayed hematopoietic recovery, were observed after chemotherapy, and a complete remission was obtained 35 days later. Jaundice and liver dysfunction also gradually improved. The patient continues to receive consolidation therapy and remains in remission 8 months after the onset of his illness.
    Download PDF (605K)
  • Kaoruko OTA, Satoshi HASHINO, Ken-ichi SHIMIZU, Masakatsu YONEZUMI, Ko ...
    2004 Volume 45 Issue 9 Pages 1044-1047
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 44-year-old man was referred to Hakodate Chuo Hospital because of progressive fatigue in April 2001, and was diagnosed as having adult T-cell leukemia (ATL; acute type). Complete remission was not obtained even with the application of multiple anti-leukemic agents including CHOP-V-MMV. The patient received an allogeneic bone marrow transplant from his HLA-identical, HTLV-I antibody-negative sibling donor in June 2002. The conditioning regimen consisted of cyclophosphamide, etoposide and total body irradiation. Cyclosporine A and a short course of methotrexate were given as prophylaxis for graft-versus-host disease (GVHD). Engraftment was achieved on day 16, while ATL cells were detected in the peripheral blood throughout the transplantation. ATL cells were also detected in bone marrow on day 20. Withdrawal of the immunosuppressant induced the eradication of the residual ATL cells in the peripheral blood on day 24 and in the bone marrow on day 40. Grade III of acute GVHD developed in the bowel on day 40, which lasted for over 5 months and was gradually resolved by administration of prednisolone and tacrolimus. The patient remains in complete remission 23 months after the transplantation. The clinical consequence of our case clearly shows that a graft-versus-leukemia (GVL) effect combined with graft-versus-host disease (GVHD) plays a curative role even in an early phase after bone marrow transplantation for patients with adult T-cell leukemia.
    Download PDF (346K)
  • Masayuki OKI, Kiyoshi ANDO, Hikaru NAKAJIMA, Yoshiaki NAKANO, Hiroyuki ...
    2004 Volume 45 Issue 9 Pages 1048-1052
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    Despite the promising outcomes of unrelated cord blood transplantations (UCBT) in pediatric recipients, the major limitation in the widespread use of cord blood (CB) as a source of hematopoietic stem cells (HSC), particularly in adults, is the physiological small number of cells. To overcome this limitation, we developed an ex vivo expansion system for HSC, in which CB CD34+ cells are cultured on feeder cells (HESS-5 cells) in the presence of cytokines (TPO, SCF and Flt3 ligand). A phase I/II clinical trial, approved by our institutional review board, has been started to assess the safety and effectiveness of this system. A 52-year-old woman with metastatic breast cancer and myelodysplastic syndrome (MDS) received a non-myeloablative preparative regimen followed by UCBT. On day 0, 75% of the whole CB and a fraction of CD34 negative cells were transplanted. The remaining 25% of the CB was CD34-selected and expanded on HESS-5 in a non-serum media in the presence of TPO, SCF, and Flt3-L. On day 5, the ex vivo-expanded, CD34+ cells were transplanted. The patient received 1.83×107/kg of total nucleated cells and 7.7×104/kg of CD34+ cells (expanded and unexpanded). No acute adverse effects were observed after the infusion of the cultured cells. She suffered from pneumonia on day 37, a cerebral hemorrhage on day 48, and died on day 50. Further studies are required to assess the effectiveness of this protocol.
    Download PDF (445K)
  • Etsuko YAMAZAKI, Aki KAMIJOH, Jun TAGUCHI, Rie HYOH, Shigeki MOTOMURA, ...
    2004 Volume 45 Issue 9 Pages 1053-1057
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 34-year-old woman was admitted for chronic graft-versus-host disease ten months after an unrelated bone marrow transplantation. Cytomegalovirus (CMV) antigenemia on day 5 of hospitalization was negative. Thrombocytopenia occurred on day 9. Laboratory findings revealed severe liver dysfunction on day 13. On day 14, the patient developed interstitial pneumonia and disseminated intravascular coagulation, and died from progressive respiratory failure. Multinucleated giant cells were found in the lung, liver, spleen, esophagus, pancreas and intestine obtained at autopsy. Varicella-zoster virus (VZV) was detected in the blood using the polymerase chain reaction (PCR) technique. CMV, herpes virus type 6 and Epstein-Barr virus were detected in the liver and lung with the PCR technique. We concluded visceral VZV infection was the main cause of her death because of her aggressive clinical course and the histology at autopsy. In this case, chronic GVHD and its immunosuppressive treatment resulted in her fatal VZV reactivation.
    Download PDF (508K)
  • Fumihiko KIMURA, Shinichi KOBAYASHI, Kazuto OGURA, Ayako KOBAYASHI, Hi ...
    2004 Volume 45 Issue 9 Pages 1058-1060
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    An increase in the presence of the Ph-negative, trisomy 8 clone has been reported in chronic myelogenous leukemia (CML) under imatinib therapy, but any impact of the clone on patient prognosis remains uncertain. We report here on a 42-year-old male with CML who received imatinib after failure of interferon-α therapy. A chromosomal analysis revealed 18/20 trisomy 8 in bone marrow at 10 months of imatinib administration. Continuing imatinib at 300 mg daily resulted in a decrease in the number of trisomy 8 clones as well as the disappearance of Ph clone. Furthermore, the patient's pancytopenia was gradually improved. Imatinib therapy could be continued even with the emergence of trisomy 8.
    Download PDF (368K)
  • Aya NAKAYA, Hiroyuki FUJITA, Takayoshi TACHIBANA, Sachiya TAKEMURA, Yo ...
    2004 Volume 45 Issue 9 Pages 1061-1063
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 37-year-old man with acute myelomonocytic leukemia (AML) M4E who exhibited the complex karyotype of 5q−, 7q−, and +22 in addition to inv(16), relapsed soon after complete remission. As previously reported, AML M4E carrying inv(16) is associated with a good prognosis, even when co-occurring with chromosomal abnormalities, which alone are considered to have poor outcome. Cytogenetic prognosis studies, such as CALGB or SWOG, have reported that certain additional chromosomal abnormalities or complex karyotypes might affect the prognosis of patients with AML M4E with inv(16). Our case suggests that, in general, AML M4E carrying inv(16) is in the favorable risk category, while cases with additional chromosomal abnormalities or complex karyotypes might be classified in the poor risk group and thus should be given additional clinical attention.
    Download PDF (200K)
  • Toyotaka IGUCHI, Mariyo SAKODA, Chien-kang CHEN, Kenji YOKOYAMA, Yutak ...
    2004 Volume 45 Issue 9 Pages 1064-1066
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 66-year-old man was referred to our hospital for the treatment of refractory multiple myeloma with thalidomide. He had a history of an interstitial pneumonia of unknown etiology two months before admission. Eight days after starting 200 mg/day of thalidomide, he developed dyspnea and fever, followed by a macropapular rash in the trunk. The dyspnea got worse and a CT scan revealed interstitial pneumonia 16 days after the treatment. He required mechanical ventilatory support. Bronchoalveolar lavage fluid revealed eosinophilia, suggesting a thalidomide-induced interstitial pneumonia. Thalidomide was discontinued and methylprednisolone (1000 mg/d×3 days) was started, and the pneumonia and rash markedly improved within six days. After that the patient contracted MRSA pneumonia and died of MRSA septicemia.
    Download PDF (277K)
  • Masahiko SUMI, Tomoiku TAKAKU, Tomotaka IGUCHI, Yuko ISHII, Tomoko KAT ...
    2004 Volume 45 Issue 9 Pages 1067-1069
    Published: 2004
    Released on J-STAGE: July 28, 2009
    JOURNAL RESTRICTED ACCESS
    A 64-year-old man with primary esophageal lymphoma suffered from dysphagia. An upper gastrointestinal examination revealed a partly ulcerated submucosal tumor in the upper portion of the esophagus. Histopathological and immunohistological examination of endoscopic biopsy specimens showed diffuse large B-cell lymphoma of the immunoblastic type. Improvement of the dysphagia and esophageal findings were noted after chemotherapy and radiotherapy. A review of the literature indicated that primary esophageal lymphomas account for less than 1% of all gastrointestinal lymphomas, and less than 0.1% of all malignant lymphomas. Because of the rarity of primary esophageal lymphoma, its clinical and biological characteristics are not currently well known. It is important to accumulate information on, and to further investigate patients with, primary esophageal lymphoma.
    Download PDF (367K)
feedback
Top